Can Practical Nurses Identify Older Home Care Clients at Risk ofDrug-Related Problems–Geriatricians’ Appraisal of Their Risk Screenings: A PilotStudy

摘要

>Background: Home care (HC) clients are increasingly older, have many chronic diseases, and use multiple medicines and thus are at high risk for drug-related problems (DRPs). >Objective: Establish the sensitivity of practical nurse (PN) administered DRP risk assessment tool (DRP-RAT) compared with geriatrician’s assessment of the medical record. Identify the clinically most significant DRPs needing action. >Methods: Twenty-six PNs working in HC of Härkätie Health Center in Lieto, Finland, 46 HC clients (≥65 years), and a geriatrician participated in this pilot study. The geriatrician reviewed HC clients’ medications using 3 different methods. The reviews were based on the following: (1) the PN’s risk screening (ie, PN-completed DRP-RAT) and medication list, (2) health center’s medical records, and (3) methods 1 and 2 together. The main outcome was the number of “at-risk patients” (ie, the patient is at risk of clinically significant DRPs) by using each review method. Secondary outcomes were clinically most significant DRP-risk predicting factors identified by the geriatrician. >Results: The geriatrician reviewed 45 clients’ medications using all 3 methods. Based on PN-completed DRP-RAT and medication list, 93% (42/45) of the clients were classified as “at-riskpatients.” Two other review methods resulted in 45/45 (100%) “at-risk patients.”Symptoms suggestive of adverse drug reactions were the most significant riskpredicting factors. Small sample size limits the generalizability of theresults. >Conclusions: The PN-completed DRP-RAT was able to provideclinically important timely patient information for clinical decision making.DRP-RAT could make it possible to more effectively involve PNs in medicationrisk management among older HC clients.